Cholesterol Treatment Guidelines

Overview

The goal in treating cholesterol is to lower your chance of having a heart attack or a stroke. The goal is not to lower your cholesterol numbers alone.

The following guidelines are from the American College of Cardiology and the American Heart Association.^{footnote 1}

The two main types of treatment are:

• Heart-healthy lifestyle.
• Medicines called statins.

The way you choose to lower your risk will depend on how high your risk for heart attack and stroke is. It will also depend on how you feel about taking medicines. Your doctor can help you know your risk. Your doctor can help you balance the benefits and risks of your treatment options.

Heart-healthy lifestyle

A heart-healthy lifestyle is always important, even if you take medicines to lower your risk.

To be heart-healthy:

• Eat heart-healthy foods.
• Lose weight if you need to, and stay at a healthy weight.
• Be active on most, if not all days of the week.
• Don't smoke.
• Manage other health problems.

Statins

You and your doctor can work together to understand your risks and what treatment is best for you. Your doctor may recommend that you take statins if the benefits outweigh the risks.

Statins strongly recommended for these people

Your doctor is likely to strongly recommend statins if you:

• Have coronary artery disease.
• Have peripheral arterial disease.
• Had a heart attack.
• Had a stroke.

Statins recommended for these people

Your doctor is likely to recommend statins if:

• Your LDL cholesterol is 190 mg/dL or above.
• You have diabetes and you are age 40 to 75.
• Your 10-year risk of heart attack or stroke is 7.5% or above and you are age 40 to 75.

Statins not as clearly recommended for these people

For some people, it's not as clear if they would benefit from a statin. To help you decide, you and your doctor can look at your overall health and any other risks you have for heart attack and stroke.

When deciding about medicines, you and your doctor may think about:

• Your family history of early coronary artery disease. Early coronary artery disease means you have a male family member who was diagnosed before age 55 or a female family member who was diagnosed before age 65.
• A high LDL cholesterol test result (160 mg/dL or higher).
• Results of tests such as C-reactive protein, coronary calcium scan, or ankle-brachial index.
• Your lifetime risk of heart attack and stroke.

Other medicines

Your doctor may talk with you about also taking a cholesterol absorption inhibitor or a PCSK9-inhibitor. These medicines can also reduce the risk of heart attack and stroke for some people. These medicines may be taken along with a statin.

Other medicines can improve cholesterol and triglyceride levels, but they have not been proven to lower the risk of a heart attack or a stroke. These medicines include bempedoic acid, bile acid sequestrants, fibric acid derivatives, and nicotinic acid (niacin).